- Develops over weeks to months
- Causative injury may be minor and forgotten
- Clinical signs and symptoms may fluctuate
- Treatment is evacuation of the clot
Intracerebral Hemorrhage
- Hemorrhage occurs into the substance of the brain
- May be due to trauma or a nontraumatic cause
- Treatment
- Supportive care
- Control of ICP
- Administration of fluids, electrolytes, and antihypertensive medications
- Craniotomy or craniectomy to remove clot and control hemorrhage; this may not
be possible due the location or lack of circumscribed area of hemorrhage
Diagnostic Evaluation
- Physical and neurologic exam
- Skull and spinal x-rays
- CT scan
- MRI
- PET (Positron emission tomography)
Management of the Patient with a Head Injury
- Assume cervical spine injury until this is ruled out
- Therapy to preserve brain homeostasis and prevent secondary damage
- Treat cerebral edema
- Maintain cerebral perfusion; treat hypotension, hypovolemia and bleeding, monitor
and manage ICP - Maintain oxygenation; cardiovascular and respiratory function
- Manage fluid and electrolyte balance